Information Technology and the NHS - Case Study Example

Introduction The fate of many projects undertaken by the companies actually depends on accurately predicting time-to-market for mission-critical Internet systems. The rate of change in the Internet and intranet development world is presently unpredictable, and estimating tools, methodologies and metrics are getting scarce. While traditional estimating, especially for client/server development, has significant applicability to Internet projects, there are significant differences. The major issue is the fact that Internet software development projects now encompass activities that were previously done prior to the software project, namely market-strategy formulation and business-process analysis. The bridging of these two domains has created new challenges in this field. Due of competitive pressures, Internet and intranet business sites are often given high priority, with senior management imposing unrealistic deadlines. Completion time may be based on nothing more formal than wishful thinking, yet, because the site deployment is integrated with many other aspects of business operations, schedule slips can have dire financial consequences. Before we explore how to plan in Internet time, however, let's review the basics of heuristic and parametric estimating. It is a well-known fact that effective project estimation is one of the major challenges in software development. Many software developers and managers acknowledge the fact that proper planning is not possible without proper estimation of the project. Under estimating a project leads to under-staffing it which in turn leads to under-scooping the quality assurance effort and in turn setting too short a schedule ultimate resulting in missing of deadlines. The software industry, as a whole has found to be not estimating projects really well. There are essentially 6 steps in the evaluation of any project and they include Estimation of the size of the project Estimation of the effort of the person in terms of time. Estimation of the schedule of the project either in months or years. Estimation of the cost of the project in the local currency. Estimation of the quality the project can guarantee. Estimation of the error rate of the project. Estimation of the size of the project A software estimation model defines characteristics whose values it needs and the ways these values are used to compute the effort. An estimation model cannot work in vacuum- it needs inputs to need the values of the output. At the start of the project, when the details of the estimates are itself not known, the estimation model will require the values of the characteristics that can be measured at any stage. Top down estimation approach Expert judgment is still the dominant technique in practice today for estimation of software project size and effort. The function points can be counted using the standard function point counting rules. In addition to the size estimate the top-down approach requires the estimation of productivity and the efficiency. The basic approach is to start with the productivity levels of standard projects or use the productivity statistics. The productivity estimate is then used to calculate the overall effort estimate. To sum it up, the top-down estimation requires Get the estimate of the total size of the software in terms of the function points. Using the productivity level from the project baseline, fix the productivity levels for the project. Obtain the overall effort estimates from the size and the time estimates. Refine the estimates taking the project specific factors into consideration. The size of the project is required to be known in order to determine the effort estimate of the project. But the size of the project cannot be known at the time when the project is being conceived and the project is in the initial phases. Hence, there must be some initial size estimate depending on the resources at hand at that moment in order to realize the effort estimate. A common approach is to use a simple equation for the effort estimate from the size estimate using the regression analysis of the similar projects done previously. Then once the overall effort is known, the effort needed for the individual activities can be determined as a percentage of the overall effort. Another approach that is commonly used is to adjust the size of the system on the basis of the obtained parameters. In the bottom-up approach, the estimates for the individual components of the system are obtained and from them the overall estimate is obtained. In this strategy, the project is broken down into major chinks and the estimate is found for these chunks out of which the overall estimate is found. Although size is required to find out other estimates for various projects, the advantage of this approach is that it does not specifically require any size estimates. In many ways, both of these approaches are complimentary. Both types of estimates are more accurate if both types of estimation mechanisms are used. For example, estimating the size becomes much more difficult when very high-level requirements are given but becomes considerably easier when the design is finished. Thus, the accuracy of estimates becomes more dependent on the point at which the efforts are estimated, with the accuracy increasing as more information about the projects becomes more available. Schedule Estimation Once the effort is known or fixed, the schedules can physically come into place depending on the number of resources available at that point of time. For example, if the effort estimate is 56 persons-months, a total schedule of 7 people with 8 months is possible. It is also possible with a schedule of approximately 9months with 6 people. As is well known, manpower and months are totally interchangeable in a software project. For instance in this case, a schedule of 1 month with 56 people is not possible even though the effort matches the requirement. In other words, once the effort is established, staffing the required people into the project can appropriately set schedules. But this flexibility is not unlimited as can be corroborated by data from the previous establishments. In other words, there is no simple equation that matches effort and manpower in software projects. "Stretching" the schedule is easy as we can withdraw people from a project. However, compressing the schedule is not so easy as more and more people need to be put into a project and this requires unnecessary grooming and increases the costs. A clear example is given earlier: compression of the 28-2 person weeks project cannot be compressed to 56-1 as this requires huge effort from a single person which is almost impossible considering the software standards. By having more resources than what exist, we usually end-up wasting the resources, which could've been used for some other cause, and the more redundancy happens in terms of work. Some approaches define the effects of compression of the schedules for any project. But for that, the normal schedule needs to be defined. The normal schedule can be defined using the effort estimate and producing a function, which could help in establishing the normal schedule. The general check list for the cost and schedule estimations Is the estimation based on a detailed description of the requirements for the system's functionality and quality Have you voted about different estimation values Do the effort estimates reflect the skill experience levels of the personnel who will be assigned to the project Does the estimating data reflect a reasonable staffing plan with the available personnel Is the estimated schedule reasonable with respect to task effort estimates, dependencies, and planned staffing Have the project manager and personnel to be assigned to the project participated in the development of the effort and schedule estimates and endorsed them Has the customer agreed to the estimating data Have the estimates been validated The National Health Services Project The National Programme for IT (NPfIT), is an initiative by the National Heath Services (NHS) in England to move towards an electronic care record for patients and to connect 30,000 General practitioners, to 300 hospitals, providing secure and audited access to these records by authorised health professionals. The Dept. of Health agency NHS connecting for health(NHS CFH) is responsible for delivering this programme. In due course it is planned that patients will also have access to their records online through a service called Health Space. NPfIT is said by the NHS CFH agency to be "the world's biggest civil information technology programme". The cost and scope of the programme, together with its ongoing problems of management, have placed it at the centre of ongoing controversy, and the Commons Public Accounts Committee has expressed serious concerns. Structure and scope of the programme On April 2005 a new agency called NHS Connecting for Health (CfH) was formed to deliver the programme. CfH absorbed both staff and workstreams. CfH absorbed both staff and workstreams from the abolishedNHS Information Authority, the organisation it replaced. CfH is based in Leeds, West Yorkshire. The programme is divided into a number of key deliverables. These are: 1)The NHS Care records service- The project describes its objectives as follows: 'Patient-centred care requires information to follow the patient so that it is available wherever and whenever it is needed. The NHS Care Records Service will allow this to happen. For the first time, information about patients will be mobile - as patients are themselves - and not remain in filing stores in the buildings where treatment or care has been received.' 2) An electronic booking service called Choose and Book Choose and Book (also known as CaB or C&B), is the name of an E-booking software application which is being introduced to the NHS in England. It is designed to enable patients needing an outpatient appointment to choose which hospital they are referred to by their genral practitionar and to book a convenient date and time for their appointment. Originally designed simply as an electronic booking system, Choose and Book was developed to enable patient choice. This application has been progressively introduced into the NHS from 2005 onwards. Interim Solutions In its fully functional mode, Choose and Book communicates electronically between 'compliant' GP Clinical Computer systems and Hospital Patient. Administration Systems (PAS). For a number of reasons a number of GP and PAS Systems have not been made compliant in time to deliver the Choose and Book targets set by the Department of Health. Interim solutions have been devised to allow patients to benefit from CaB during 2005/6. Web Based Referral (WBR) allows a GP to access Choose and Book via a standard Web Browser until their Clinical Computing system can be successfully upgraded. Indirectly Bookable Services (IBS) involves telephone Call Handlers in Hospitals to offer CaB appointments to patients. In a compliant environment. CaB 'harvests' appointment slots from the Hospital PAS. IBS allows a patient to speak to someone who can validate their identity, offer a choice of convenient dates and times from the PAS, then update CaB with details of the chosen appointment. Progress to date The roll-out of CaB in 2005 & 2006 suffered a number of delays; some technical because of its dependency on other NPfIT work streams, partly through functional problems in early releases, and partly through clinicians' concerns about additional workload. There are conflicting views about its effectiveness, both from a technical viewpoint (it is hard to distinguish between bugs in CaB and the systems with which it interfaces) and a service perspective (some users argue that it undermines existing good practice, while others praise the convenience and reduced delays it offers to patients.) In order to increase the uptake of Choose & Book by doctors in England, surgeries were offered a financial incentive for the first part of 2006 to 'come on board', but it continues to suffer from adverse publicity in the medical press and resistance from a number of GPs. Since the application became more stable during 2005 and 2006, volumes have increased, albeit more slowly than planned. At December 2006, over 1500,000 patients had benefited from CaB. By the end of January 2007, this had risen to almost 2.5M bookings, with daily figures of 15-20,000. All Primary care trusts(PCTs) in England are live with Choose and Book (although that may only be one GP within a PCT or practice), while all NHS Acute Trusts are using Choose and Book.) At 28th January, about 90% of practices are actively providing the service, and while some PCTs are only seeing low volumes (20% and less in some cases), many are booking 70 to 80% of patients using Choose and Book. 3) A system for the Electronic Transmission of Prescriptions (ETP) The ETP (Electronic Transfer of Prescriptions) is a project within the National Programme for IT of the National Health Service in England to provide for the electronic transfer of medical prescriptions from doctor to pharmacist as opposed to the current paper-based method. 4) A new national broadband IT network for the NHS (N3) N3 is the name of the broadband network being developed by the UK National Health Service (NHS). The service, which began its roll-out in 2005, is managed by the BT Group on behalf of the NHS. By enabling electronic communication between different elements of the NHS, it will support Choose and Book, the NHS Care Records Service, electronic prescriptions, transfer of patient information and many other initiatives which are a part of the National Programme for IT. The intention is that all NHS care providers will use N3, which will therefore replace the multiplicity of systems used to date by the present NHS communications framework NHSNet. Connections to N3 are strictly controlled by the Connecting for Health Information Governance group, which specifies the security required and data protocols allowed under its Code of Connection agreements. Organisations wishing to provide information or applications to their NHS partners over N3 are faced with a choice of applying for their own Code of Connection, which generally requires a considerable investment in time (typically 6 months), effort and infrastructure, or partnering with one of the restricted number of organisations able to use their own Code of Connect for these purposes. 5) Picture Archiving and communication systems 6)NHS Mail- a central email and directory service for the NHS. NHSmail was renamed to Contact in late 2004, before being reverted to NHSmail in April 2006. Read More